Background

Although caring is a core concept in nursing, its meaning is not uniform, and perceptions may vary across care settings. In ambulance care, encounters with older patients with complex care needs present challenges that may shape how caring is understood and practiced. Guided by a lifeworld-led caring perspective, this study explores how caring is perceived and enacted in this specific clinical context.

Aim

This study aims to describe variations in nurses' perceptions of caring in ambulance encounters with older patients with complex care needs.

Methods

This qualitative study employed a phenomenographic approach to identify variations in nurses' perceptions of caring in ambulance encounters with older patients with complex needs. Semi-structured interviews with 16 nurses in ambulance care from two regions in Sweden were analysed using a phenomenographic method.

Ethical Considerations

Ethical approval was granted by the Swedish Ethical Review Authority. All participants provided informed consent to participate.

Results

The outcome space comprised three qualitatively different ways in which nurses perceived caring: ‘Caring as balancing symptoms and medical care’, ‘Caring as negotiating responsibility’, and ‘Caring as responding to an ethical demand’.

Conclusions

Caring in ambulance encounters with older patients with complex care needs is perceived as a multidimensional and contextually situated practice that integrates clinical, relational, and ethical dimensions. While caring was often expressed in terms of balancing symptoms and medical interventions, it also involved moral sensitivity, relational engagement, and professional responsibility. These findings contribute to a deeper understanding of caring as a lifeworld-led and ethically grounded practice in ambulance care, with implications for education, reflective practice, and policy development.

The purpose of both precision medicine and precision nursing is to improve patient outcomes. This theoretical article is designed as a conceptual and position paper situated within caring science, with a specific focus on understanding precision nursing across diverse clinical contexts. Rather than presenting empirical findings, the paper synthesizes theoretical perspectives, caring science foundations, and selected scholarly literature. In this position paper, we seek to expand the concept of precision nursing from a caring science perspective with clinical examples, vignettes, from an emergency care context. Precision medicine can be viewed as an effort to truly individualize a treatment and make it as accurate and effective as possible. While the focus on measurable outcomes saves lives, it also carries the risk of narrowing attention to what can be observed and quantified. These visible clinical markers represent only part of what matters in care. To get the full picture of a patient and their treatment, caring must serve as the foundation for precision nursing, as it is caring that ensures that technological advancements remain aligned with individual patient needs. Precision medicine and precision nursing may offer direction, but to provide meaning to the concepts, a grounding in caring science is provided in this study.

Introduction The involvement of older adults as active partners in research is increasingly being promoted to improve the relevance and impact of scientific knowledge. However, the evidence base on how older adults have been involved as active partners in healthcare research remains fragmented. To our knowledge, no review of reviews has yet provided a comprehensive overview of this body of evidence. Therefore, this umbrella review aims to synthesise review-level evidence on the involvement of older adults as active research partners. We address three questions: (1) How have older adults been involved as active partners in research? (2) What terminology, models and frameworks have been used? (3) What benefits and challenges have been reported related to involving older adults as active partners in research?

Methods and analysis This study will follow the Joanna Briggs Institute (JBI) methodology for umbrella reviews. A comprehensive search will be conducted in Medline, CINAHL, Scopus, PsycINFO, Sociological Abstracts and Web of Science. Eligible reviews will be those reporting on the involvement of older adults (aged 60 years or older) as active partners in research. Two reviewers will independently screen titles, abstracts and full texts and perform data extraction using a standardised form. Methodological quality will be assessed using the JBI Critical Appraisal Checklist for Systematic Reviews. Findings will be synthesised narratively and thematically, with attention to reported roles, terminology, conceptual frameworks and the benefits and challenges of involvement.

Ethics and dissemination As this umbrella review draws exclusively on secondary data from published sources, ethical approval is not required. Older adults, engaged as independent public contributors, have been involved in shaping the review protocol and will take part in interpreting the findings. Results will be disseminated through a peer-reviewed journal and presentations at academic and stakeholder conferences, and used to inform the design of a subsequent mixed-methods study focused on strengthening the involvement of older adults as active partners in research.

PROSPERO registration number CRD420251064947.

Background

Coordinated, multidisciplinary care is essential when addressing the complex needs of an aging population, with prehospital emergency care providers often serving as a common point of contact. Addressing complex care needs while maintaining continuity of care necessitates seamless collaboration between diverse healthcare providers. Despite this, there is limited research on interprofessional collaboration in prehospital care of older patients with complex needs. Understanding what influences interprofessional collaboration and identifying areas for improvement are vital for optimizing prehospital care for this vulnerable population. This study aimed to explore ambulance clinicians' perspectives on interprofessional collaboration in prehospital emergency care for older patients with complex care needs and to identify key factors influencing collaboration.

Methods

An explanatory sequential mixed-methods design was employed in this study, conducted in southern Sweden. In Phase 1, quantitative data were collected via an online survey completed by 118 ambulance clinicians (ACs). Descriptive statistics, chi-square tests, and Kruskal–Wallis tests were used to analyze the data. Qualitative responses were analyzed through inductive content analysis, informing the development of an interview guide. In Phase 2, semi-structured interviews were conducted with 20 ACs and analyzed using inductive content analysis. Findings from both phases were integrated using a joint-display matrix, combining quantitative patterns with qualitative insights for a comprehensive interpretation.

Results

Quantitative findings revealed that although collaboration with patients' families and care staff was generally rated as satisfactory by ACs, significant challenges were reported in coordinating care with other healthcare actors, especially home care nurses. About 89% of respondents reported insufficient access to patient information, highlighting difficulties in retrieving such information. Qualitative data underscored the importance of comprehensive patient information for effective decision-making and alignment with patient preferences and care goals. The integrated analysis identified three key factors influencing interprofessional collaboration: defined goals of care, access to information, and clarity in roles and responsibilities. Challenges in maintaining continuity and responsiveness, particularly during night shifts, were emphasized as barriers to effective collaboration.

Conclusion

Addressing deficiencies in nighttime care coordination, improving access to comprehensive patient information, and strengthening communication pathways between healthcare providers are essential steps in improving interprofessional collaboration to strengthen prehospital care of older patients with complex care needs.

Aim: To explore frontline decision-making, adaptation, and learning in ambulance care during the evolving COVID-19 pandemic.

Design: Descriptive and interpretative qualitative study.MethodsTwenty-eight registered nurses from the Swedish ambulance services described 56 critical incidents during the COVID-19 pandemic through free-text questionnaires. The material was analysed using the Critical Incident Technique and Interpretive Description through the lens of potential for resilient performance.

Results: The findings were synthesized into four themes: ‘Navigating uncharted waters under never-ending pressure’, ‘Balancing on the brink of an abyss’, ‘Sacrificing the few to save the many’ and ‘Bracing for the next wave’. Frontline decision-making during a pandemic contribute to ethical dilemmas while necessitating difficult prioritizations to adapt and respond to limited resources. Learning was manifested through effective information sharing and the identification of successful adaptations as compared to maladaptations.

Conclusions: During pandemics or under other extreme conditions, decisions must be made promptly, even amidst emerging chaos, potentially necessitating the use of untested methods and ad-hoc solutions due to initial lack of knowledge and guidelines. Within ambulance care, dynamic leadership becomes imperative, combining autonomous frontline decision-making with support from management. Strengthening ethical competence and fostering ethical discourse may enhance confidence in decision-making, particularly under ethically challenging circumstances.

Impact: Performance under extreme conditions can elevate the risk of suboptimal decision-making and adverse outcomes, with older adults being especially vulnerable. Thus, requiring targeted decision support and interventions. Enhancing patient safety in ambulance care during such conditions demands active participation and governance from management, along with decision support and guidelines. Vertical communication and collaboration between management and frontline professionals are essential to ensure that critical information, guidelines, and resources are effectively disseminated and implemented. Further research is needed into management and leadership in ambulance care, alongside the ethical challenges in frontline decision-making under extreme conditions.

Introduction Making decisions about the appropriate level of care is a significant challenge for healthcare professionals, especially when older patients present with diffuse symptoms. Collaboration between ambulance services and primary care may promote a comprehensive understanding of patient needs. However, such collaboration remains limited, potentially leading to lower care quality and higher costs. There is a need to understand how collaboration can be effectively implemented. This scoping review aims to explore existing models of collaboration between ambulance services and primary care, identifying their characteristics, outcomes and current research gaps.

Methods and analysis This scoping review will follow the methodological framework proposed by Arksey and O’Malley, supplemented with recommendations from the Joanna Briggs Institute Handbook for Scoping Reviews. A comprehensive literature search will be conducted in PubMed, CINAHL, Web of Science and Scopus. In addition, Google Scholar, Overton, SwePub and the Swedish national library database Libris will be searched for relevant grey literature. The review will include studies published from January 2014 to the present. Data will be analysed descriptively, with findings categorised by collaboration models and patterns identified through inductive analysis to address the research questions. The review will apply the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews to present the results.

Ethics and dissemination This review is the first stage of an overarching research study to develop a model for extended collaboration between ambulance services and primary care (the ECAP project). Results will be disseminated through peer-reviewed publications, conference presentations and sharing with ambulance services and primary care stakeholders to inform practice and policy. This scoping review protocol has been registered on the Open Science Framework (https://osf.io/nrkm5/). No participants will be involved at this stage, and the selected literature is publicly available, so no ethical approval will be required for this scoping review.

Aim: The overall aim was to explore inter-organizational collaboration and adaptability in care coordination, focusing on seamless care for patients with complex care needs.

Methods: This thesis employed diverse qualitative methodologies across four studies. Studies I–III used an ethnographic approach with convergent data collection techniques, including document review, participant observations, and interviews with healthcare and social care professionals. Studies I and II applied the Functional Resonance Analysis Method to explore care transitions and identify vulnerabilities. Study III constructed a grounded theory of inter-organizational collaboration from insights across healthcare and social care domains. Study IV utilized a web-based questionnaire to collect written critical incidents reported by registered nurses in ambulance care. These incidents were analyzed using Critical Incident Technique and Interpretive Description, focusing on adaptation, decision-making, and learning in ambulance care during the COVID-19 pandemic. Lastly, findings from all studies were synthesized.

Findings: Seamless care for patients with complex needs depends on timing and precision in planning and information exchange across care provider boundaries. Gaps in these processes can increase vulnerabilities (I, II). Effective care coordination relies on bridging professional and organizational divides through established collaboration pathways while stretching across organizational boundaries, rather than dissolving them (III). Continuous learning is central, leveraging lessons learned from adaptations made under pressure to foster resilience and ensure effective care delivery (IV). Coordinating care in organizational borderlands—the spaces where professional roles and organizational boundaries intersect—requires continuous communication, negotiation, and shared decisionmaking. Adaptability enables healthcare professionals to navigate the complexities of real-world care and bridge the gap between protocols and practice by balancing standardized procedures with context-specific, flexible decision-making.

Conclusion: Well-defined boundaries, established collaboration pathways, and adaptability are necessary to overcome challenges in fragmented healthcare systems. When maintained with flexibility, boundaries facilitate coordination by defining roles and responsibilities while still allowing healthcare professionals to adapt to emerging situations. Rather than needing to be dissolved, boundaries provide a structure that reduces ambiguity and supports effective collaboration. Striking a balance between stability and adaptability is, therefore, essential for achieving seamless care for patients with complex care needs.

Aim: The aim of this study was to visualize vulnerabilities and explore the dynamics of inter-professional collaboration and organizational adaptability in the context of care transitions for patients with complex care needs.

Design: An ethnographic design using multiple convergent data collection techniques.

Methods: Data collection involved document review, participant observations and interviews with healthcare and social care professionals (HSCPs). Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings.

Results: Inconsistencies in timing and precision during care transitions pose risks for patients with complex care needs as they force healthcare systems to prioritize structural constraints over individualized care, especially during unforeseen events outside regular hours. Such systemic inflexibility can compromise patient safety, increase the workload for HSCPs and strain resources. Organizational adaptability is crucial to managing the inherent variability of patient needs. Our proposed ‘safe care transition pathway’ addresses these issues, providing proactive strategies such as sharing knowledge and increasing patient participation, and strengthening the capacity of professionals to meet dynamic care needs, promoting safer care transitions.

Conclusion: To promote patient safety in care transitions, strategies must go beyond inter-professional collaboration, incorporating adaptability and flexible resource planning. The implementation of standardized safe care transition pathways, coupled with the active participation of patients and families, is crucial. These measures aim to create a resilient, person-centred approach that may effectively manage the complexities in care transitions.

Implications: The recommendations of this study span the spectrum from policy-level changes aimed at strategic resource allocation and fostering inter-professional collaboration to practical measures like effective communication, information technology  integration, patient participation and family involvement. Together, the recommendations offer a holistic approach to enhance care transitions and, ultimately, patient outcomes.